The heart is the main, constantly working organ of the circulatory system. The heart works under the influence of its own pacemaker. Pulses leading to heart contraction are produced by special cells of the right atrium located in its upper part, called the sinus node (Flack-Keith node).
The main characteristics of sinus rhythm are:
- frequency of beats per minute – ranging from 60 to 90;
- regularity – each impulse follows after an equal period of time;
- sequence – with each impulse, the excitation sequentially passes from the atria to the ventricles;
- ability to change depending on physiological conditions (sleep, wakefulness, stress).
Sinus rhythm is a heart rhythm that occurs under the influence of impulses from the Flack-Keith node. This rhythm is characteristic of all healthy people, including pregnant women.
The heart contracts under the influence of electrical impulses more than a hundred thousand times a day. These pulses are generated and carried out by special cells. Thanks to this process, the heart contracts rhythmically and supports the body.
Arrhythmia is a violation of the conduction and rhythm of an organ. In this case, the frequency and strength of the contractions of the heart changes. Premature, extraordinary contractions may occur, or the sequence of contractions of the ventricles and atria may change.
Arrhythmia during pregnancy does not always indicate pathology.
Women are at greater risk of developing disorders:
- with heart defects;
- undergoing surgery on the organ;
- with congenital pathologies of the conduction system, in which the tone of the sympathetic department increases and the autonomic nervous system is overloaded.
In most cases, if there are no health problems, cardiac arrhythmias occur due to:
- disorders of the gastrointestinal tract;
- failures in the functions of the nervous and endocrine systems;
- pathologies of the upper respiratory tract;
- disorders of metabolic processes in the body;
- excessive physical and emotional stress;
- eating large amounts of fried, fatty and high-calorie foods;
- fluid abuse. It accumulates in the body and overloads the heart;
- drinking alcohol and smoking while bearing the fetus;
- severe toxicosis, disturbing throughout pregnancy.
The next referral to the hospital of the gynecological profile is often perplexed by the woman and relatives. The statement that “she will give birth” is not suitable in a particular case.
The fact is that pregnancy contributes to changes that greatly complicate the usual use of tablets in the average therapeutic dosage for adults. These include:
- a significant increase in the volume of circulating blood – therefore, the dosage taken orally is diluted in concentration and becomes less active, individual selection of the number of tablets is required;
- reduced protein content (hypoproteinemia) – it binds the incoming drug worse;
- increased renal blood flow – enhances the removal of medicines from the blood.
For these reasons, it is difficult to treat arrhythmias in pregnant women on an outpatient basis. In a hospital, there is more opportunity to observe a reaction to drugs, to monitor the ECG picture in a timely manner, and to check tests.
Optimally selected drugs can be taken at home. Relatives can not forget about caring for the expectant mother and baby, providing them with proper nutrition and attention.
Arrhythmia can occur for the following reasons:
- diseases of the heart, blood vessels and nervous system;
- disorders of the endocrine system;
- external factors: bad habits, physical or emotional stress, malnutrition;
- problems with the gastrointestinal tract;
- respiratory tract diseases;
- metabolic disorders.
Arrhythmia during pregnancy can manifest itself in both early and late stages.
Most often it is caused by:
- heart defects;
- pulmonary insufficiency;
- hormonal failure;
- endocrine disorders;
- bad habits;
- poor metabolism;
- lesions of the central nervous system;
- a change in blood count;
- lack of micro and macro elements.
Why are arrhythmias and pregnancy often related? The fact is that during the bearing of the fetus the body of the future mother is the most vulnerable, and failures can appear even if the woman had no signs of heart disease before conception.
The most common causes of arrhythmias in pregnant women are:
- various diseases and heart diseases;
- diseases of the respiratory system leading to respiratory failure and affecting the functions of the cardiovascular system;
- lesions of the central nervous system;
- endocrine disorders;
- changes in normal electrolyte metabolism;
- hereditary predisposition.
Sinus arrhythmia and its types in pregnant women
Sinus arrhythmia is the most common type of arrhythmia in pregnant women. It occurs when the regularity of impulse generation changes in the sinus node:
- with an increase in impulses emanating from the sinus node, sinus tachycardia occurs;
- with their decrease – sinus bradycardia;
- if the impulses are generated unevenly, they speak of sinus arrhythmia.
Most often this is due to the action of the ANS and is functional in nature.
With sinus tachycardia, the patient complains of a heartbeat, increased irritability, poor sleep, and an increase in blood pressure is sometimes noted.
With sinus bradycardia, weakness, fainting, chilliness, tearfulness, and a decrease in blood pressure are noted.
These conditions do not require antiarrhythmic therapy. Women are given general recommendations, light sedatives, autogenic exercises are recommended, the safety of these arrhythmias is explained in great detail, both for the pregnant woman and for her unborn child.
If sinus arrhythmias are caused by cardiac pathology or occur against a background of heart failure, then in these cases small doses of digitalis preparations, adrenergic receptor blockers (β-blockers), and potassium containing drugs are prescribed.
Arrhythmia has different types. Their difference in the frequency of strokes, locations in the organ of the pathological focus. In severe cases, rhythm disturbance is a serious danger to the life of a woman and a child. With the development of the fetus, the risk of complications increases, so treatment is necessary.
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Arrhythmia in pregnant women can occur in the form of extrasystole.
In the normal state, all impulses that cause contractions of the heart are generated in the sinus node. This ensures the coordinated work of the ventricles and atria.
But under the influence of pathological processes, extrasystoles are formed in certain parts of the organ in connection with an increase in the electrical activity of cells. Distinguish single and group impulses.
At the first manifestations, it is necessary to undergo an examination. Extrasystole is not accompanied by vivid manifestations, but most patients report the presence of:
- interruptions in the work of the heart;
- sensation of fading of the organ;
- pain in the chest;
With arrhythmias caused by bad habits, in order to stabilize the work of the heart, it is necessary to draw up the correct regimen, eat healthy food, walk on air daily, avoid anxiety and completely abandon addictions.
With extrasystoles, which were diagnosed during the passage of electrocardiography, an additional examination is prescribed to exclude the presence of congenital or acquired defects, rheumatic heart disease, cardiomyopathy, ischemic myocardial lesions.
Such treatment can be prescribed according to ECG indications; during the study, the fraction of blood ejection into the aorta is determined. If the indicators are not higher than 40%, then adrenergic blockers are needed.
At the same time, the intervals between the contractions of the myocardium are not the same and alternate incorrectly. This leads to periodic slowdowns and accelerations of the heart. The development of sinus arrhythmia in pregnant women may be associated with:
- restructuring of basic systems;
- severe pathologies of infectious origin;
- impaired functions of the autonomic nervous system;
- a strong increase in body weight, which leads to an increase in the load on the heart.
A future mother in this condition may feel:
- Feeling of a heartbeat and its fading.
- Shortness of breath.
- Darkening in the eyes.
- Sudden fainting.
Severe forms require serious treatment. Such an arrhythmia during pregnancy in the early stages is not treated with antiarrhythmic drugs. A woman should strictly follow the doctor’s recommendations.
To improve health, it is necessary to normalize body weight, take vitamin complexes, and lead a moderately active lifestyle.
It is important to do exercises every day, to walk in the fresh air. Useful yoga.
This is a serious violation of the heart rhythm, in which not all impulses reach from the atria to the ventricles. This is accompanied by a change in frequency and rhythm. The problem can manifest itself in the form of fluttering, in which the heart rate can exceed 300 beats, flicker. The heart in this case beats chaotically and more often than with trembling.
This pathology must be treated very urgently, since it can cause the formation of blood clots that cause pulmonary embolism, thrombosis of blood vessels in the brain and coronary arteries. To stabilize the rhythm, take such measures:
- Parenteral string method is administered Novocainamide.
- Radiofrequency ablation is performed to protect the embryo.
- Electropulse therapy.
The treatment option is selected individually.
Late arrhythmia during pregnancy occurs in the form of paroxysmal tachycardia. It can develop regardless of heart disease. Attacks can appear several times during the day. They last from a few seconds to three days.
In the case of a prolonged course of paroxysmal tachycardia, the tone of the uterus increases and a miscarriage is possible.
During the attack, the pulse suddenly increases to 150 strokes, dizzy, discomfort in the chest, weakness occurs.
If there are pathologies of the myocardium, then nausea with vomiting is added to the main symptoms.
With heart pathologies, in order to normalize contractions, cardiac glycosides are used. If there is a decrease in blood pressure, Novocainamide is administered intramuscularly.
Pathology develops in pregnant women with a history of heart disease. In this case, manifestations of paroxysmal tachycardia and other arrhythmias are observed. With a combination of the disease with atrial flutter, the likelihood of ventricular fibrillation and death increases.
The syndrome is not accompanied by specific symptoms, so it can be detected on an electrocardiogram.
The problem is not life-threatening in most cases, but it is important to monitor your condition and be observed by a doctor, as in the event of a hormonal failure, the situation can dramatically worsen.
Therapy is prescribed in the presence of arrhythmia. With supraventricular tachycardia, Novocainamide is administered. In severe cases, electropulse therapy is used.
If treatment fails, then implantation of an artificial pacemaker is necessary.
Blockade in pregnant women
The passage of impulses occurs along nerve fibers. But with some inflammations, accompanied by tissue necrosis, coordinated regulation is disrupted, which leads to the development of blockades.
Pathologies of the second and third severity are dangerous. They are accompanied by dizziness and loss of consciousness.
To restore normal rhythm, you need to install a pacemaker. With it, you can improve the prognosis for the life of the mother and fetus.
Naturally, a woman will not be able to give birth to a child, as the heart will not withstand the load. Therefore, a cesarean section is performed.
Arrhythmia in the fetus is caused by diseases or metabolic disorders.
The problem can be benign or malignant, in which heart failure develops.
Slowing of contractions as a result of anemia, low pressure in the mother, crushing of the umbilical cord, i.e., insufficient oxygen supply, can be observed.
To avoid this problem, you must:
- Refuse sleep while lying on your back. This will remove compression of the vena cava.
- Follow a special fortified diet.
- Engage in light exercise in the air and walk every day.
- Be sure to see a doctor.
Intrauterine infections, chromosomal abnormalities, anemia, hypoxia can cause fetal arrhythmias. Timely diagnosis and proper treatment will eliminate the problem during the first year of life.
Determine the pathology in a child with the help of:
- ultrasound examination;
You can listen to the work of the heart using ultrasound already in the eighth week of pregnancy. To detect pathologies in the structure of the heart, a four-chamber projection is used. A woman must also undergo echocardiography in order to examine the blood flow in the departments of the child’s organ.
Cardiotocography allows you to assess the condition of the vessels of the uterus and the child and identify developmental abnormalities.
Similar problems in a baby do not always indicate serious pathologies. Often the condition normalizes by itself. But a woman should be under the supervision of doctors.
Antiarrhythmic drugs during pregnancy
Arrhythmia is a violation of the heart rhythm, and this condition is considered a pathology. During pregnancy, such a disease can occur for the first time, and may worsen if a woman, while not yet pregnant, felt this condition earlier.
By the complexity of the course of the disease, these types of heart rhythm disturbances are distinguished:
Extrasystole is a condition of premature heart contraction. The discomfort behind the chest with this form is palpable, but such malfunctions are cons >
Sinus (respiratory) – alternating slowdown or acceleration of the rhythm of cardiac work. This form of arrhythmia is especially dangerous and can indicate the presence of more serious heart diseases, although it is considered normal during pregnancy: the fetus is a new circle of blood circulation, which, in fact, causes an additional load on the mother’s heart system. Like any type of heart rhythm failure, it threatens the fetus with oxygen starvation.
Variability is the range of environmental changes in the body, in which a person can exist without risk for homeostasis. Variability characterizes the reserve capacity of the body.
The cardiovascular system is built on the principle of subordination, where the lower departments of regulation work autonomously, and the higher ones are connected only when the lower ones cannot perform their functions. The heart works autonomously, but under altered environmental conditions (stress, stress, illness), it is influenced by nervous and humoral factors, adapting its work to new conditions.
The greatest impact on the work of the heart is provided by the ANS (autonomic nervous system). The sympathetic department, manifesting through the action on beta-adrenergic receptors, accelerates the heart rhythm, the parasympathetic department through cholinergic receptors slows down the work of the heart.
The act of breathing, being a complex physiological process, is also regulated by the ANS. When you inhale, the vagal innervation is inhibited – the pulse rate becomes faster, when you exhale, the vagus becomes irritated – the heart rate slows down.
Analyzing the heart rate variability, we can say how much the body can cope with all the changing factors. Pregnancy, although it is a physiological state, places high demands on the body. Heart rate variability shows how well the body copes with these requirements.
The body of a woman is subject to the greatest physiological load in the early stages of gestation. This is due to hormonal and functional restructuring of the whole organism. Almost every woman is faced with functional types of arrhythmias that are caused by:
- a decrease in the overall stress resistance of the body;
- increased tone of the sympathetic nervous system;
- disturbances in electrolyte metabolism due to early toxicosis.
These arrhythmias do not harm either the mother’s body or the developing fetus. To reduce the severity of these symptoms, a woman is recommended:
- to be outdoors more;
- eat right and in a timely manner;
- eliminate the influence of such harmful factors as smoking (even passive) and alcohol.
However, a situation is possible where an increased load on the body is manifested by previously latent (hidden) diseases, including diseases of the cardiac sphere (cardiopathy, myocardial dystrophy). In these cases, the appearance of such severe types of arrhythmias as:
- weakness of the sinus node;
- ventricular tachycardia;
- violation of the processes at various levels.
These types of arrhythmias that threaten the life of the mother cannot but affect the process of fetal formation and the development of various pathologies in the future. In cases where arrhythmias threaten the life of a pregnant woman, the question arises of abortion. But more often a woman is placed in a hospital, she is prescribed an individually selected antiarrhythmic treatment.
In the later stages of pregnancy, a woman experiences not only functional, but also physical activity:
- increased body weight due to increasing weight of the fetus and placenta;
- functional hypervolemia (increase in blood volume);
- accelerated metabolism;
- hormonal activity of the placenta;
- the bottom of the enlarged uterus presses on the heart and large vessels.
All these are arrhythmogenic factors and lead to the fact that almost every woman in late pregnancy experiences bouts of sinus tachycardia.
For the mother and the fetus, a heart rate of less than 110 beats per minute is not dangerous. If severe rhythm disturbances occur, then the patient is placed in a hospital. At this stage of pregnancy, when the basic systems and organs of the fetus are already formed, doctors can use a larger arsenal of antiarrhythmic drugs and methods.
Atrial fibrillation occurs under the influence of a large number of nerve impulses, which cause an irregular contraction of individual muscle groups, which makes a coordinated atrial contraction impossible.
The presence of atrial fibrillation in pregnant women indicates severe cardiac pathology, the most significant complications of which are hemodynamic and thromboembolism disorders, which are dangerous for both the mother and the fetus.
If atrial fibrillation existed before pregnancy and is chronic, then subjectively it may not be felt. In the event of the first paroxysm, patients complain of:
- interruptions in heart contractions;
- shortness of breath;
- feeling of fear.
The first paroxysm usually goes away on its own. If this does not happen, an electrocardioversion or catheter ablation is performed, having previously protected the fetus with a lead apron. Control over the frequency of ventricular contractions, in cases of threat of hemodynamic complications, is carried out using digitalis preparations or adrenergic drugs in small doses.
Very difficult is the issue of anticoagulation therapy. In these cases, drugs that do not cross the placenta (heparin) are used. Management of pregnancy and childbirth with atrial fibrillation is a difficult task, therefore it is safer to carry out ablation (rhythm restoration procedure) at the stage of pregnancy planning.
During pregnancy, under the influence of various causes (hormonal background, electrolyte disorders, increased sympathetic activity), foci appear in the heart that can generate electrical impulses, which causes additional contractions of the heart muscle, which slow down the rhythm – extrasystole.
Usually, atrial and nodal extrasystoles are functional, and ventricular extrasystoles can be the result of organ pathology. Although the transition of ventricular extrasystole to ventricular rhythms is a debatable issue, however, the presence of a large number of extrasystoles, group and polytopic, creates electrical myocardial instability.
Complaints with extrasystole can be very different. Sometimes patients complain of: sudden interruptions in heart contractions, accompanied by a feeling of fear, lack of air, unpleasant pain in the pericardial region. In other cases, complaints may be missing.
Usually extrasystole does not require antiarrhythmic therapy. If a woman subjectively does not tolerate extrasystoles, sedative therapy and small doses of beta blockers are prescribed. In cases of group and polytopic ventricular extrasystoles, lidocaine or Novocainamide are prescribed.
Paroxysmal tachycardia is a group of arrhythmias characterized by separate sudden onset seizures. At the same time, a high heart rate is observed – up to 200 beats per minute. The duration of the attacks may vary.
According to the development mechanism, paroxysmal tachycardia is similar to extrasystoles and is always preceded by them. The basis of paroxysmal tachycardia is the circulation of pulsed excitation, sometimes the cause of paroxysmal tachycardia becomes an additional focus of excitation.
Paroxysmal tachycardia often occurs after 22 weeks of pregnancy, it can occur both with cardiac pathology and in its absence.
Short-term paroxysms of treatment do not require and do not threaten either the fetus or the mother.
A protracted attack can cause hemodynamic disturbances.
This is a serious condition manifested:
- a decrease in the ejection fraction below 40% and the phenomena of circulatory failure;
- decreased blood circulation in the heart and ischemia;
- decreased blood circulation of the brain and various neurological symptoms;
- various autonomic disorders;
- possible development of severe forms of arrhythmia.
The cessation of the attack can occur spontaneously with a decrease in physical exertion and mild sedative therapy.
Stopping the attack begins with vagal samples (pressure on the eyeballs, straining, inducing vomiting).
If this also has not yielded results, transesophageal pacing is performed.
With unstable hemodynamics, electrical cardioversion is immediately performed.
The occurrence of the most dangerous forms of paroxysmal tachycardia – ventricular paroxysmal tachycardia – is not typical during pregnancy. There are short seizures (up to 30 seconds) without hemodynamic disturbance and longer ones with circulatory disorders and severe ventricular arrhythmias. This condition requires immediate defibrillation and cardiopulmonary resuscitation.
WPW syndrome is characterized by the presence of a Kent beam – an additional channel for conducting electrical pulses. By itself, this syndrome does not give any clinic, but it predisposes to the development of various types of arrhythmias, the most dangerous of which is atrial fibrillation. With this syndrome, it often causes ventricular fibrillation. Therefore, all pregnant women with this syndrome are observed by a cardiologist.
Signs and symptoms
The most recognizable symptoms of arrhythmia during pregnancy are:
- sensation of a broken heart rate;
- dizziness ;
- dark spots before the eyes;
- “Jumping out” of the heart of the chest.
Arrhythmia during pregnancy can be cured, although it is not very easy to do. Due to changes in the female body, the dose of antiarrhythmic drugs, which are necessary in order to maintain heart tone, may increase. It is important to consider that the body may to some extent reject drugs.
Since the protein level is reduced, the concentration of substances in the blood is less. In addition, increased liver metabolism and renal blood flow, which is why drugs are excreted quickly from the body, and their quantity is quite high. It is very important to consult a doctor in a timely manner, who will give all the necessary recommendations.
If atrial fibrillation is treated during pregnancy, it is worth considering some points.
- It is necessary to establish the cause and effect on the following factors: cessation of alcoholic beverages, treatment of hyperthyroidism, elimination of an overdose of glycosides, and so on.
- It is necessary to control the state of the heart, stop and prevent the following attacks during pregnancy.
- Thromboembolism should be prevented. If the ciliated form is permanent, the doctor is likely to prescribe antithrombotic therapy.
The form of extrasystole usually does not require medical intervention, as well as the rejection of natural childbirth. Some drugs can be prescribed by a doctor only after a comprehensive examination, as well as in case of a threat of ventricular tachycardia.
Sinus arrhythmia is treated after the examination, in particular the ECG, and the exact form of the disease is revealed. If it signals the presence of another disease, you need to understand this issue and, after a more accurate conclusion, give recommendations. If arrhythmia is associated with breathing, a more complete examination is also worthwhile. However, with minor consequences of this form, the violation does not require specific treatment, since it does not cause any special disturbances.
Arrhythmia will be frightened of such a correct way of life and will not visit a person who is so caring for himself. In any case, careful attention to your health, especially during pregnancy, will reduce the risk of complications and greatly increase the chances that everything will be in order with the health of the baby and his mother.
In the case when a cardiologist prescribes medication, it is agreed with the leading gynecologist. Treatment includes the same principles and methods as for non-pregnant women, the adjustment is made only for the dosage and drugs allowed during the period of pregnancy.
The key to getting rid of the ailment is the correctly established cause of its occurrence.
What treatment methods can be used for arrhythmias in pregnant women? Only a doctor can answer this question after an examination.